ABS QE Flashcards
(145 cards)
1
Q
what is the composition of fluid in chlyous acities?
A
High TG(>110 or x2 plasma level, Low cholesterol, leukocytosis with lymphocytic predominance and negatie cultures
2
Q
Top 2 MC methods of injury in old ppl?
A
1) falls 2) MVC
3
Q
what enzyme cleared fastest in acute pancreattis?
A
Amylase < 48 hrs
4
Q
What day does max collagen accumulation occur?
A
day 21 Type I collagen right before phase three begins and degredation occurs
5
Q
Epidermal tumor with peripheral pallisading of nuclei with stromal retraction. Diag?
A
Basal cell (most common cancer overall
6
Q
Diag Malignant degeneration of epithelial cells with differentiation toward keratin
A
SCC
7
Q
Absolute CI to stenting across the left subclavian artery?
A
1)Aberrent/ Left dominant vertebral, 2) CABG using IMA (cardiac ischemia) 3) LUE AVF
8
Q
1cm skin lesion concerning for melanoma on forearm NSM?
A
Full thickness narrow margin excision biopsy with 1 to 3mm of nomral skin and fat (punch bx if large > 2cm or sensative area
9
Q
melanoma stage if postive LN?
A
Stage III
10
Q
Most common gene mutation in CRC?
A
APC
11
Q
which gene mutation would alter tx of metastatic colon ca?
A
KRAS (unable to use anti-EGFR targeted therapy)
12
Q
Positive DPL in blunt trauma?
A
10 mL of gross blood, bacteria, bile, food particles; or infusate >100,000 RBCs or >500 WBCs.
13
Q
Tx for metastatic carcinoid?
A
Debulking for symptoms and somatostatin anlaog (lanreotide)
14
Q
Surgical approach to access peroneal artery for bypass ?
A
infapopliteal approach medial or laterally (requires fibulectomy)
15
Q
what are the borders and nerve contents in triangle of pain?
A
Medially: spermatic vessels, laterally and sup ileopubic tract (IL).. (Contains femoral branch of genitofemoral and lateral cutaneous n thigh)
16
Q
When to do ppx thyroidectomy with CLND in MEN2A vs B
A
B: before 1 yr old, A: Before 5 yrs old
B = bad
17
Q
1.5-cm purple, raised, subcutaneous nodule over his forearm and palpable axillary lymphadenopathy. Bx large, pale nuclei (with salt and pepper chromatin) and scant cytoplasm. Each cell has whorled paranuclear plaques (Blue cells)
A
Merckle cell ca
18
Q
How to differentiate merckle cell ca from Small cell lung Ca?
A
Both CD 20 +, MCC negative for thyroid transcription factor 1 TTF-1), SCC postiive for both
19
Q
what are the two primary bile acids synthesized by the liver?
A
Only the primary bile acids (cholic acid and chenodeoxycholic acid) begin with the letter “C.”
20
Q
MC bacteria to cause lymphangitis?
A
Strep pyogenes
21
Q
how to diagnose hereditary pancreatitis?
A
x2 1st degree relatives or x3 second degree over 2 generations or positive for cationic trypsinogen gene (PRSS1 AD)
22
Q
why does elevated ICP cause diplopia
A
6th nerve palsy resulting in LR weakness from brainstem depression
23
Q
what are 3 main biases of ca screening test
A
1) lead time (clock starts early) 2) Length time (tests find non aggresive cancers 3) self selection
24
Q
which paralytics undergo hoffman degedation?
A
ataracurium and cisatracurium
25
Nerve injury resulting ln dec sensation over the posterior-lateral foot and leg following ablation of SSV?
Surval Nerve
26
what defines stage III of pericardial tamponade?
Pericardial P approaches LVEDP resulting in cardiac collpase death
27
2 cm carcinoid in mesentary 22 cm from IC valve causing SBO tx
segemental SBR with assoc mesentary with enteroenterostomy (2cm margins)
28
MC indication for liver trn?
Hep C
29
Tx of x3 < 1cm T1a Gastric NET (carcinoid) w/ elevated gastrin levels??
Endoscopic resection if less than 1cm, < 6 nodules, and no muscular invasion. Otherwise antrectomy. Consider source MEN 1 vs atrophic gastritis
30
Suspicious features on mammography for cancer
irregular masses with spiculated margins and high density, and pleomorphic, linear, branching, and segmental calcifications
31
What population at risk for pressure ulcers?
Pysch, depressed patients -> imobility poor nutrition
32
2nd MC paraneoplastic syndrome associated with thymoma?
1) MG 2) Pure red blood cell aplasia
33
Blood supply to rectal stump in colorectal anastamosis
Inferior hemmorhoidal artery (via the internal illiac)
34
41 yo F with 6cm peripheral to central enhancing liver lesion on CT w/ sxs Diag and Tx?
Hemangioma, tx resection (anatomical if central, enucleation if peripheral)
35
MC congential bleeding disorder and inheritance pattern?
Von Willebrand Dz Type I, AD (quan def of WvF -> instability of factor 8-> dec VIII and vWF -> Coagulapathy
36
Fastest way to increase oxygenation in intubated patient?
Increase FIO2, other way would be inc PEEP takes hours
37
MC RF for SCC of the lower lip
UV radiation (sunglight)
38
Concerning factors for breast can discharge
unilateral, clear or bloody discharge, guiac postiive
39
Diag & tx of 1.5 cm thyroid mass with microcalcifications ?
Non diff thyroid ca (papillary) need total thyroidectomy central neck dissection NOT necessary unless clinically positive nodes
40
what are the 3 specific site PTH works to inc Ca++ absorb?
1) Kidney @ Distal convoluted tubule 2) Stimulates osteoclasts in bone 3) Activiation of Vita D -> Inc ca gut absorption. Also stim phos trashing at PCT
41
Hcl Burn initial treatment stable airway no systemic signs of hypoCA
Ca gluconate gel to burn (Acid binds Ca++ -> HypoCa++). Intra arterial Ca w/ Mg
42
NSM asthmatic with GERD
ppi 1st line then consider EGD if no improvement
43
AD syndrome assoc w/ breast, soft tissue sarcoma, ACC, brain tumors, leukemia
p53 Li framieni
44
Syndrome and gene associated with RCC, hemangioblastoma (retina/CNS), pheo
Von hippeau Linda's (VHL gene(
45
Treatment for stage III Hidraadenitis refractory to medical tx
WLE w/ STSG or other tissue coverage
46
SVC 2/2 sq cell ca curative tx?
Radiation. If palliative can consider stent and chemo first but sq cell very radiosensitive
47
NSM w/u 8 cm leg soft tissue sarcoma after MRI
CNB can consider excisional bx if <5cm
48
Vit C def error in collagen synthesis?
Failure of proline hydroxylation (in ER) -> defective pro-a chain -> unstable collagen triple helices
49
16 F ovarian torsion w/ 6cm cyst. Tx?
Detorsion with ovarian cystectomy
50
landmarks, positioning thoracentesis
Sitting upright with needle btw spine and posterior axillary line 8th ICS (Above 10th)
51
Clustered calcifications on mammograpy
MCC of DCIS (linear benign vascular) THINK ducts are clustered together
52
CNB complex sclerosing lesion NSM?
Excisional biopsy
53
Excisional bx for atypical ductal hyperplasia with positive margins NSM?
No further tx
54
Meds that contribute to gynocomastia in males ?
Dig, thiazides, estrogens theophylline
55
Diagnostic criteria for IFB in patient with peau d orange, < 6 mo sxs
Need bx confirming invasive cancer, tumor invasion into dermal lymphatics not enough
56
Tx for all types of phyllodes tumor malignant? SLND?
WLE with at least 1 cm margin no SLND (acts like a sarcoma spreads blood)
57
Most appropriate diagnostic modality to diagnose pancreatic divisum
MRCP w/ secretin - visualize dorsal pancreatic duct crossing ant to CBD and draining via minor papilla w separate Ventral duct (Pathoma)
58
4 wk old with persistent jaundice. Normal HIDA. NSM?
Ig assay for infectious causes (TORCHES) of neonatal hepatitis. Normal HIDA r/o biliary atresia
59
12 yo w recurrent pancreatitis 2/2 pancreatic divisum tx?
ERCP w sphincterotomy of minor papilla
60
Effect of increase PEEP (2)
1. Inc aveolar recruitment -> inc FRC 2. Dec veous return, dec preload, dec LVEP, dec SV
61
1 cm stable pt with stab wound left of umbilicus NSM
wound exploration -> + CT vs obs ....if negative d/c home
62
What reflex can be present in brain death?
lower limb withdrawl response (No brainstem reflex allowed spinal reflexes okay)
63
Ideal CPP in TBI patients?
Between 60-70 with ICP of <20. CPP > 70 brain edema/ARDS CPP < 50 ischemia
64
what receptor does vasopressin bind?
V1 G coupled receptor
65
Criteria for liver trn for HCC?
1) No extra hepatic dz or vascular involvement Meets Milan criteria one lesion less than 5 cm or up to three lesions all less than 3 cm (Note UCSF criteria more liberal total lesions have to be less than 8cm
66
#1 sx in 50% of pt w/ achalasia
Dysphagia (S+L) = functional >> mechanical issue (not stricture, tumor); Solids > 50% & liquids 2/3 of pts
67
operative step to avoid gastric band slippage?
insert band through a tunnel through the pars flaccida
68
Diff post vagotomy diarrhea vs dumping syndrome?
PVG - watery diarrhea and urgency with NO relation to meals
69
Tx post vagotomy diarrhea
1) inc fiber, dec carb and lactulose, stop caffenine 2) cholecystiramine
70
Associated with chromosome 11 deletion cryptorchism, hypospadius, MR, biliateral absent iris
WAGR Syndrome (W= Wilms tumor)
71
Surg tx for malrotation?
Ladds Procedure 1) evicerate bowel incise outer leaftlet to fan the mesentary
72
MC type of intussception?
ileocolic #1 least common is ilealileal
73
MCC after strictureplasties
bleeding 9%
74
Protrusion of rectal mucosa in radial pattern
prolapsed internal hemmorhoids TV
75
Age to begin CRC screening 35 yo m w FH 38 yo bro with 1.2 cm TV adenoma
38 (1st degree relavtive w adv adenoma (>1cm, HGD, villuous or TV, serrated adenoma start screening at 40 yo or age of onset of adenoma in relavtive whichever is first)
76
45 yo F w/x2 < 1cm tubular adenomas w/o dysplasia colonoscopy next?
7-10 yrs
77
Normal velcoities on Carotid Duplex U/S of ICA
"ICA PSV is < 125 cm/sec and plaque or intimal thickening is visible sonographically. Additional criteria include ICA/CCA PSV ratio < 2.0 and ICA EDV < 40 cm/ses
=125 cm/sec 50% stenosis (can be sx at this point), >230 > 70% stenosis "
78
Triphasic waveform vs biphasic
Biphasic up and down stroke without flow reversal
79
Preop Fistula Artery and vein sizes
2mm for arteries and 2.5 mm for veins
80
Tx of DVT following endovenous ablation < 50%
EHIT (endothermic heat induced thrombosis) diff from DVT. weekly surveillance. TLOV if >50
81
Most common site of atheroscerlosis?
Branch points. (>40% stenosis compromises vessel lumen)
82
Definitive tx for aorta enteric fistula following open AAA repair?
Graft explanation and extra anatomical bypass
83
Submucosal 3cm dumbellshaped stomach mass tx
GIST (c-kit, CD117) . Tx resection with grossly - margin (unless > 3cm or > 5 mitosis HPF -> Gleevac)
84
80 yo F w HF intubated in ICU on pressers with fever increasing WBC with U/S showing gallbladder wall thickening and echogenic shadowing. Tx?
Perc Chloe tube for a calculus Chloe
85
31 yo m with 1 yr painless unilateral testicular mass increasing in size past 3 mo extending to ext ring that transilluminates? Diag?
31 yo m with 1 yr painless unilateral testicular mass increasing in size past 3 mo extending to ext ring that transilluminates? Diag?
86
Healthy 25 yo with califlower lesions around anus NSM of workup?
Anoscopy and Proctosigmoidoscopy to evaluate for intracolonic dz. Dont need to do full colonoscopy
87
Tx for horseshoe abscess?
Hanlay prcoedure 3 incisions. x1 posterior midline to drain posterior (deep postanal space), x2 laterally to drain ischiorectal fossas
88
Peripheral blood smear finding in patient with ITP and functioning splenic tissue?
Decreased platelets and normal appearing RBCs. Findgins assocaited with asplenia include heniz body, HJ body target cells etc
89
ET CO2 changes with malignant HTN versus CO2 embolus
Malig HTN inc in CO2 2/2 inc metabolic state fever everything else CO2 embol, arrest, bronchospasm, PE all dec CO2
90
Best operative tx for SMA snydrome
Try conservative 1st feeding tube, reglan. If fails MC operation duodenojejunostomy to bypass blockage
91
Study of how organism affects the drug?
Pharmacokinetics (metabolism, excretion, aborption) whereas dynamics is how drug affect body ie ligand binding to receptor
92
Is multifocal dz a CI to BCT w/ invasive cancer?
No but multifocal centric IS (in more than one quadrant of the breast)
93
Surgical tx for patient with idopathic atonic 'esophageal dysmotility w/o achalasia or stricture?
Partial fundoplication anterior dor or posterior toupet.
94
When is partial wrap absolute C/I in patient with esophageal dysmotility?
Achalasia or scleroderma
95
what is monoclonal abx used in melanoma?
Pembroluzimab (monoclonal ab that prevents downstream signaling of PD-1)
96
Indications for damanage control laparotomy?
Hemodynamic instability Acidosis <7.2, Base deficit >15, temp <34, transfusion >12 L, refractory coagulapathy (based on lab values and clinical assesment
97
Term for TP + FN / total indviduals studied
Prevlenace
98
Anatomical landmarks for paracentesis
3 cm medial and superior to ASIS on LEFT, avoid right lactulose causes cecal dilation
99
Uncontrolled DM with PNA hemoptysis and ischemia on bronch with broad nonseptated hyphae Diag & tx?
Mucomycosis (mucor and rhizous) Tx aggresive Liposomal Amphotericin B, intubation, Pulmonary resection for debridment contrast w aspergillus
100
ADH acts on which receiptors in kidney to increase water reasorption?
V2 (two kidneys). V1 Smooth muscle vasoconstrict
101
11 yo with recurrent vomiting after meals w double bubble Diag?
Annular pancreas (delayed presentation)
102
3o yo m Colon cancer with yellow facial Papules. Bx sebaceous carincoma
Muir Torre Syndrome (AD variant of HNPCC/Lynch syndrome
103
Better survival rate of luminal subtypes ?
Luminal A >> B in terms of survival (ER, PR + HER 2 -) BETTER TO GET A's than B's on test
104
MEN 2 what tumor marker followed Postop total thyroidectomy with CNL dissection
Calcitonin (From parafollicular C cells) opposes PTH used to monitor for recurrence of MTC
105
Treatment for high output thoracic duct leak 2/2 malig pulm?
Chemo radiation if persists -> OR for pleurodesis (80% success)
106
Vitamin A def?
Xeropthalamia (can't cry), Rashes
107
Vit E def?
Hemolytic anemia and neuromuscular disorders
108
How to calculate Na deficit.
Na deficit = (desired Na - Patient Na) * TBW ; TBW = weight kg *60 males or 50% females
109
Tx of UTI in pregnant pt with PCN allergy?
Nitrofuratonin. Bactrim is folic acid antagonist
110
Chews tobacco slowly growing mucosa lower lip pedunculated 3 cm attached to mucuosa Diag and tx
Verrucous ca (subset of scc that pushes rather than invades looks velvety and bad but isn't) NSM WLE with flap reconstruction (Moh's only for cutaneous sec)
111
SCC anal canal 3 cm s/p chemo radiation regressing now 1cm - LN
Observe if getting small f/u 6 mo anoscopy ->if persists @ f/u APR; Repeat bx if enlarging
112
CDH detected on 18 week prenatal U/S NSM?
Fetal MRI, ECHO, genetic evaluation to confirm consider vertebral and cardiac abnormalities
113
which polypossi syndrome is a subset of FAP and Lynch syndrome respectively?
FAP - Gardner colon polyposis, Desmoid, cranial osteomas, cutaneous lesions (epidermal inclusion cysts and lipomas); HPNCC (Lynch) subtype Muir Torre sebaceous gland tumors
114
32 yo painless, solid testicular masss on U/S, NSM?
Radical inguinal orichectomy(remove testicle and spermatic cord through inguinal ring
115
Criteria to qualify for observation of malig pedunculated polyp which was endoscopically resected? Follow up screening?
4 Criteria. Pedunduclated, single specimen, completely removed w/clear margins, favorable histology (pT1, grade I or II and no angiolymphatic). Follow up endoscopy q1 year
116
Tx for NOMI from urosepsis?
Intra arterial papaverine infusion (infusion of vasodilator)
117
Preop Cardiac W/u for noncardiac surgery (elective hernia 55 yo, >4 METS)?
No further testing need
118
Drug added to Folfox regimen for poor response to chemo for nonop metastatic colon ca?
Cetuximab (anti EGFR tx)
119
NCCN Guidelines pt w hx of adenomatous polyp + high risk feat. (serrated, HGD, SSP-d, villious or. Tubulovillous histo, bet 3-10 or >.1cm ?
Repeat colonoscopy in 3 years
120
1cm black lesion conc for melanoma…NSM? Margins?
Excisional biopsy of skin and fat with 1-3 mm margins, if less than 2 cm in size (incisional/punch)
121
Best tx for Hurley stage III Hidraadenitis ?
Extensive local excision with STSG coverage (Don't just do I&D!)
122
What melanoma pt gets SLNB?
All >1mm or >0.8 + high risk feats (ie mitotic rate >1mm^2 or ulceration)
123
Firm Flesh covered plaques with finger like projections of spindle cells on histo?
DFSP (dermatofibrosarcoma protuberans)
124
NSM s/p WLE of 1.2 malignant melanoma with 2 positive LN w adequate margins?
Observation (Don't do completion node dissection!!! MSLT-2 trial)
125
Red/purple raised, dome shaped subcu nodule w.o "rolled edge"?
MCC (Merle cell ca) looks like basal cell
126
Lesion + for cytokeratin 20 and negative for TTF (thyroid transcription factor)?
MCC (Merle cell ca)
127
Lesion + for cytokeratin 20 and + for TTF-1 (thyroid transcription factor)?
Small cell ca of lung
128
W/u for palpable LN with melanoma
1st CNB vs FNA to confirm met -> if neg excision of node OR if pos lymphadenectomy (levels I-III) during resection
129
Where do you make incision for felon finger?
Vertical incision over the fingertip pulp (avoid lateral neurovasc) and don't past DIP joint or bluntly dissect septa (tendon)
130
Diag test for 18 yo "double jointed with painful bump below knee?
CT angiogram of chest (classic Ehlers-Danos) type 5 collagen to look for aortic root aneursym
131
Oozing melanoma resection risk of wound infectioin?
1-2% Clean However SLNB higher 5%
132
LIRNEC score specificity and sensitivity for NST?
High specificity low sensitivity (can't use to rule out infection)
133
Stage of 5cm truncal sarcoma w/ nodal involvement no other met
Stage IV if any nodal involvement (diff from RP sarcomas)
134
Follow up for stage I melanoma?
Surveillance only! (H&P 6-12 mo for 5 years)
135
how to close femoral canal
Suturing IL to pectineal ligament using interrupted absorbable suture.
136
Diagnosis nonhealing ulcer 57 yo DM obese HMB-45 positive immunochemistry?
Melanoma (+HMB-45, Melan-A, S-100 protein) markers….NOT DM foot ulcer!
137
What sarcoma requires WLE w/ Sentinel LN biopsy if clinically node negative?
Rhabdomyosarcoma in peds pt
138
CDH detected on 18 week prenatal U/S NSM?
Fetal MRI (NEXT BEST STEP), ECHO, genetic evaluation to confirm consider vertebral and cardiac abnormalities
139
MCC in Hirschprung's and best pull through anastamosis to prevent it?
Anastamotic stricture, end to side (rectum -> small bowel)
140
Most common presenting symptom in pt's w/ ASD?
Dyspnea and shortness of breath 2/2 CHF (usually in adulthood)
141
NSM metastatic neuroblastoma on labs and MIBG scan?
Biopsy to determine N-myc status then chemo followed by radiation
142
Persistent jaundice with normal HIDA NSM?
immunoglobulin assay for TORCHES infection
143
6 wk old with persistent jaundice 2/2 biliary atresia NSM?
Kasai procedure heptaportalenteroenterostomy
144
Indication for indomethacin tx in neonate?
Close persistent PDA
145
Fredet-Ramstedt pyloromyotomy treats pyloric stenosis by dividing the hypertrophied pyloric muscle until what layer seen?
Gastric Submucosa/mucosa buldge out into "olive mass"
